1.

What anticoagulant medication is generally avoided during pregnancy?

Warfarin (Coumadin)—warfarin is a teratogen and can cross the placenta to cause fetal bleeding and hemorrhagic death of fetus.

2.

A healthy 32-year-old female is found to have secondary infertility. She has developed worsened premenstrual symptoms (PMS) since her pregnancy and now has dyspareunia. Laparoscopy finds growths on the ovaries and peritoneal surfaces. What is the likely cause?

Endometriosis: estrogen-dependent implants of endometrial tissue found outside the uterus. Endometriomas are most commonly seen in the peritoneum (bladder, cul-de-sac, pelvic wall, ligaments, ovaries, fallopian tubes, and rectovaginal septum) as well as liver, bowel, umbilicus, and lung.

3.

What is used for pregnant women with antiphospholipid syndrome but have never had an adverse outcome related to the condition?

Low-dose aspirin

4.

What is the differential diagnosis for galactorrhea?

Pituitary adenoma, pregnancy-induced lactation or recent weaning, nonmilky nipple discharge, intraductal papilloma, fibrocystic disease; if purulent breast discharge, consider mastitis, breast abscess, impetigo, eczema. If bloody breast discharge, consider malignancy.

5.

How should women with antiphospholipid antibody syndrome and history of early miscarriages be treated to prevent miscarriage?

Either 81 mg ASA alone or in combination with low molecular weight heparin (LMWH)

6.

A young woman is obese and has hirsutism. What laboratory outcomes are associated with polycystic ovary syndrome (PCOS)?

LH: FSH ratio > 2.5:1

Hyperglycemia/insulin resistance

Elevated testosterone levels

Normal prolactin levels (elevated prolactin may imply a pituitary tumor causing PCOS-like syndrome)

7.

A 19-year-old female has lower abdominal pain for the last 8 days without fever; urine hCG is negative. On exam, she has pain with cervical range of motion and white discharge from the os. What is the likely cause?

Pelvic inflammatory disease (PID); Centers for Disease Control and Prevention (CDC) recommend empiric treatment for PID if one or more of the following minimum criteria are present on pelvic exam in an at-risk patient: cervical motion tenderness, uterine tenderness, and adnexal tenderness in the presence of lower abdominal or pelvic pain.

8.

What condition is associated with a decreased alfa fetoprotein level?

Down syndrome

9.

Emergency contraception is most efficacious when it is given within what time frame?

As early as possible, and best within 72 hours

10.

How does emergency contraception influence an existing pregnancy?

Emergency contraception does not interfere with an existing pregnancy (i.e., patient was raped and presents for emergency contraception but was unknowingly pregnant weeks before the rape). Emergency contraception also does not cause fetal malformations.

11.

What is the most accurate measure of gestational age in the second or third trimester?

Biparietal diameter, the transverse diameter of fetal head on ultrasound

12.

What is the leading cause of congenital hearing loss?

Cytomegalovirus (CMV)

13.

What are the long-term sequelae of having contracted PID?

A history of PID infection increases the risk of infertility, ectopic pregnancy, and recurrence of infection.

14.

What is the most common cause of urinary tract infections in pregnant females?

Escherichia coli

15.

What risk is increased in a pregnant woman with asymptomatic bacteriuria?

Increased risk of preterm delivery

16.

Preterm labor is defined as

Regular contractions with cervical change before 37 weeks of gestation

17.

In women with recurrent pregnancy loss, what coagulation disorder should be tested for?

Antiphospholipid antibody syndrome

18.

PCOS is associated with what clinical manifestations?

Menstrual irregularities: oligomenorrhea or amenorrhea

Hyperandrogenism: hirsutism, acne

Insulin resistance: obesity, diabetes mellitus type 2

19.

What drug can be used safely in the treatment of Graves disease during first trimester of pregnancy?

Propylthiouracil (PTU)

However, recent guidelines recommend transitioning PTU to methimazole in the second trimester, as the risk of hepatotoxicity in PTU outweighs the teratogenic effect on organogenesis in the first trimester by methimazole.

20.

A woman develops painless vaginal bleeding at 36 weeks of pregnancy; what is the greatest worry?

Placenta previa presents with painless bleeding during the second and third trimesters. Placenta previa is when placental tissue extends over or lies proximate to the internal os. Complete/total previa: Placenta covers the entire os. Partial previa: Placenta covers part of internal cervical os.

21.

Why is methimazole generally NOT used in the first trimester for the treatment of Graves disease during pregnancy?

Methimazole is associated with congenital abnormalities, and can cross the placenta to induce hypothyroidism in the fetus if not dosed correctly.

22.

What are the clinical benefits of raloxifene?

Raloxifene is a selective estrogen receptor modulator (SERM) that acts as an estrogen antagonist in the breast and uterus, but has agonist activity on bone.

As a result, it is used in breast cancer treatment and prevention as well as postmenopausal osteoporosis.

No increased risk in endometrial cancer (as opposed to tamoxifen) but it does increase risk of deep vein thrombosis (DVT).

23.

Tamoxifen can increase the risk of what malignancy?

Endometrial carcinoma; tamoxifen is an estrogen antagonist in the breast but has agonist activity in the uterus.

24.

When should cervical cancer screening be started, and repeated?

At age 21 years

Repeat:

• 
  

  If 21-24 years and human papillomavirus (HPV) negative, repeat in 3 years

  
  
• 
  

  If 25-30 years and HPV negative, repeat every 3 years

  
  
• 
  

  If ≥30 years and HPV negative, repeat every 5 years

25.

What is the danger of using trimethoprim/sulfamethoxazole (Bactrim/Septra) in the third trimester of pregnancy?

Kernicterus. Sulfonamides can displace bilirubin from albumin and lead to elevated unconjugated bilirubin levels.

26.

Recommended management options for women 21-24 years with atypical squamous cells of undetermined significance (ASC-US) include

Reflex DNA testing for oncogenic HPV types

Or

Repeat cytology in 12 months

27.

Define metrorrhagia.

Bleeding occurring at irregular intervals, typically between normal menstrual cycles

28.

Define menometrorrhagia.

Heavy or prolonged bleeding occurring at irregular, noncyclic intervals

29.

What position should pregnant women be advised to sleep in?

Pregnant women should be advised to lie in the left lateral decubitus position because the uterus can compress the great vessels, resulting in decreased uterine blood flow.

30.

Name the clinical benefits to using oral contraceptives.

Decreased risk of endometrial and ovarian carcinoma (benefit occurs with 1 year of use)

Reduction in dysfunctional uterine bleeding (DUB), menorrhagia, and dysmenorrhea

Improvement in acne, hirsutism

Improved pelvic pain secondary to endometriosis

31.

What are the 2015 FDA classifications on medications used during pregnancy?

FDA issued new drug labeling guidelines that remove the product letter categories A, B, D, X. The new system has three categories: pregnancy, lactation, and females and males of reproductive potential. Risk summary, clinical considerations, and data are described for each category.

32.

How frequently should women with a hysterectomy for noncancerous reasons receive a pap smear?

Further pap smears are not necessary.

33.

A patient with symptoms of galactorrhea and has an elevated prolactin level. The next appropriate test is

MRI of the pituitary with gadolinium enhancement

34.

What are the clinical findings consistent with congenital rubella syndrome?

Cardiac: patent ductus arteriosus, pulmonary artery stenosis

Ophthalmologic: cataracts, retinopathy, glaucoma

Neurologic: behavioral disorders, meningoencephalitis, mental retardation

Auditory: sensorineural hearing loss

Hematologic: thrombocytopenia (petechiae and purpura), hyperbilirubinemia

35.

For patients to be diagnosed with bacterial vaginosis, what are the Amsel criteria?

1. 
   

   pH > 4.5 (most sensitive)

   
   
2. 
   

   Clue cells > 20% (most specific)

   
   
3. 
   

   Homogenous, thin, grayish white discharge

   
   
4. 
   

   Positive whiff test (amine odor with KOH application)

Patients should test positive for three out of four to make the diagnosis.

36.

Epidurals in delivery are associated with what adverse effects?

Increased duration of second stage of labor and increased risk of maternal fever

37.

PCOS is associated with which conditions?

Endometrial carcinoma

Infertility

Chronic oligomenorrhea/amenorrhea in PCOS leads to decreased progesterone and unopposed increase in estrogen.

38.

What are the risk factors for endometrial cancer?

Excessive and unopposed estrogen exposure

Tamoxifen therapy

Obesity

Late menopause

Diabetes mellitus

Nulliparity

Hypertension (HTN)

39.

Contraindications to combination oral contraceptives include

A history of venous thromboembolism, stroke, cardiovascular disease, or peripheral vascular disease

Smoking if age 35 or over and ≥ 15 cigarettes/day is a relative contraindication.

Active liver disease

Estrogen-dependent cancers

Untreated HTN (controlled HTN is not)

40.

Define fetal macrosomia.

Macrosomia is when a fetus weighs more than 4,000 g. Fetal macrosomia is no longer an indication for induction or cesarean section.

41.

What biochemical marker is most clinically useful at identifying impending preterm delivery?

Fetal fibronectin in cervical or vaginal secretions helps identify impending preterm delivery.

42.

What is the risk of leaving a diaphragm in place for more than 24 hours?

Toxic shock syndrome

43.

Painful lesions or nodules found on the shins of women taking birth control pills or newly pregnant:

These nodules are consistent with erythema nodosum. This condition can also occur in inflammatory bowel disease, sarcoidosis, Behcet syndrome, multiple other conditions (strep infections, mononucleosis, hepatitis C), and with the use of multiple medications (sulfonamides, omeprazole, bromides).

44.

What biochemical marker is useful in detecting ectopic pregnancy at 5 weeks’ gestation?

Serum hCG level

Serum hCG should double every 72 hours in a viable pregnancy; in ectopic pregnancies and nonviable intrauterine pregnancies, hCG levels will plateau or rise but at a slower rate.

45.

What embryonic or fetal finding is detectable when the hCG level is 17,000 mIU/mL?

Cardiac activity can be detected.

> 1,000 mIU/mL: a gestational sac can be visualized in the uterus (usually 5 weeks’ gestation).

> 2,500 mIU/mL; yolk sac is visible.

> 5,000 mIU/mL: usually the fetal pole can be detected.

46.

Vaccines that are safe to provide during pregnancy include

Tdap

Hepatitis B vaccine

Influenza vaccine

Meningococcal vaccine

Rabies vaccine

47.

What clinical signs and symptoms imply an inevitable pregnancy loss?

Inevitable abortion: bleeding, open os, impending passage of product of conception

48.

What signs and symptoms imply an incomplete abortion?

Incomplete abortion: bleeding, open os, some passage of products of conception in os or vagina

49.

What signs and symptoms imply a threatened abortion?

Threatened abortion: bleeding, closed os, no products of conception in os or vagina; fetus still in utero and viable

50.

What signs and symptoms imply a completed abortion?

A completed abortion: bleeding, closed os, complete passage of products of conception on ultrasound.

A missed abortion: mild bleeding or cramping, closed os. Loss of early pregnancy symptoms like nausea or breast tenderness, but can also be asymptomatic. Embryo or fetus still present on ultrasound, but no longer viable.

51.

What are the main signs and symptoms of septic abortion?

Fever, signs of sepsis, foul smelling vaginal discharge, bleeding, and abdominal pain

52.

What increases the risk of a septic abortion?

Induced abortions are more likely to lead to septic abortion than spontaneous abortions.

53.

A pregnant patient in the first trimester presents with vaginal bleeding. What are your next management steps?

Pelvic exam should be done to assess cervical os opening and signs of spontaneous abortion, ultrasound, and hCG levels.

Spotting can be normal in early pregnancy but vaginal bleeding in the first trimester is ectopic pregnancy until proven otherwise.

54.

What are the major complications associated with retained products of conception?

Coagulopathy and infection

Patient should get repeat ultrasound after initial management to confirm products of conception are all gone.

55.

Besides early sexual activity and multiple partners, what behavior increases the risk of cervical cancer?

Smoking

56.

What are the clinical findings associated with HELLP syndrome?

HELLP syndrome is a potentially life threatening complication of late pregnancy that may be a variant of pre-eclampsia. It is associated with Right Upper Quadrant pain and the following:

Hemolysis

Elevated liver enzymes

Low platelets

Right upper quadrant (RUQ) pain

57.

A 38-year-old female presents with acute left lower quadrant (LLQ) abdominal pain and you are concerned about an ovarian torsion. What test will help make the diagnosis?

Ultrasound with color Doppler

58.

What antibiotics are contraindicated during pregnancy?

Trimethoprim/sulfamethoxazole can cause kernicterus.

Fluoroquinolones can affect cartilage development.

Tetracyclines can affect growth and staining of teeth.

59.

Define the first stage of labor.

Time from the start of regular contractions to complete dilation of the cervix

60.

What marks the beginning and the end of the second stage of labor?

Time between complete dilation of the cervix to delivery of the baby

61.

What class of antihypertensive medications is contraindicated in all stages of pregnancy?

Angiotensin converting enzyme (ACE) inhibitors

62.

What antihypertensive medications are considered safe during pregnancy?

Long-acting nifedipine

Labetolol

Thiazide diuretics

Methyldopa

63.

When treating eclampsia with magnesium sulfate, what physical exam finding is lost?

Deep tendon reflexes

64.

When should screening for Chlamydia be instituted?

Screen all sexually active women age 24 years and younger and in older women who are at increased risk.

65.

A pregnant woman at 38 weeks has vaginal bleeding. What test should be ordered on vaginal secretions to discern maternal vs fetal blood?

The Apt test is used to discern if the source of late pregnancy bleeding is the infant’s or the mother’s blood.

66.

What are the risk factors for pre-eclampsia?

Nulliparity; age >40 years; family history of preeclampsia; high body mass index; diabetes; chronic HTN, chronic renal disease, or both; multifetal pregnancy; previous preeclampsia; systemic lupus erythematosus; in vitro fertilization

67.

The criteria for preeclampsia include

• 
  

  New onset elevated BP (SBP >140 mm Hg or DBP > 90 mm Hg on two occasions at least 4 hours apart or > 160/110 mm Hg) after 20 weeks of gestation and

  
  
• 
  

  Proteinuria or

  
  
• 
  

  New onset thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral/visual symptoms

68.

What is first line therapy for endometriosis?

Combination oral contraceptives

69.

Late in a pregnancy, a woman develops severe pruritus associated with papules and plaques. What is the likely diagnosis?

Pruritic urticarial papules and plaques of pregnancy (PUPPP)

70.

When treating Chlamydia, how long should a patient wait before engaging in intercourse?

7 days

71.

What is a vasa previa?

Vasa previa is when blood vessels within the placenta or the umbilical cord are trapped between the fetus and the birth canal, increasing risk of hemorrhage due to a blood vessel injury when the fetal membranes rupture or during labor and delivery.

72.

What factors increase the risk for placental abruption?

Prior abruption (strongest risk factor)

Cocaine and other drug abuse

Abdominal trauma

Eclampsia

Preeclampsia or chronic HTN

Smoking during pregnancy

Increased maternal age

Increased parity

73.

What is the worrisome cause of severe abdominal pain and vaginal bleeding in the third trimester

Placental abruption until proven otherwise

74.

What is the likely diagnosis of a patient that has a frothy vaginal discharge with a pH >4.5? On exam she has a “strawberry cervix.”

Trichomonas vaginalis

75.

What is the treatment of choice Trichomonas vaginalis?

Oral metronidazole; the partner should also be treated.

76.

Postmenopausal endometrial thickness greater than what measurement would suggest the possibility of endometrial hyperplasia or carcinoma?

5 mm

77.

Folic acid is used to prevent what birth defect?

Neural tube defects; patients planning a pregnancy should take a daily supplement of 0.4-0.8 mg at least 1 month prior to conception. Women with a prior history of a pregnancy affected by a neural tube defect should take 4 mg/day.

78.

A woman has cystic swelling lateral to the vaginal opening; you diagnose an infected Bartholin gland cyst. What is the treatment?

If infected, mainstay treatment is incision and drainage (I&D) with insertion of Word catheter.

Marsupialization is more invasive and done in the Operating Room (OR) if it fails to resolve with one or two placements of Word catheter.

If Bartholin cyst is asymptomatic, no treatment is necessary.

79.

What is a missed abortion?

Missed abortion is defined as a dead fetus or embryo without passage of tissue, with a closed cervix.

80.

What is a blighted ovum?

Blighted ovum is defined as a failure of the embryo to develop despite the presence of a gestational sac and placental tissue.

81.

During pregnancy, what is the most common cause of jaundice?

Viral hepatitis

82.

About 3 months following an uncomplicated delivery, a woman develops symptoms of anxiety, unexplained weight loss, and a rapid heart rate. A few months later, she develops fatigue, dry skin, and constipation. What is the likely diagnosis?

Postpartum thyroiditis; it develops following an uncomplicated delivery in two phases. The inflammation of the first phase induces symptoms of hyperthyroidism including anxiety, weight loss, tachycardia, and heat sensitivity; TSH will be suppressed. The second phase has symptoms of hypothyroidism, including fatigue, dry skin, cold sensitivity, and constipation; here, the TSH will be elevated. The condition is self-limiting within 18 months.

83.

How is postpartum thyroiditis with an elevated TSH treated?

Thyroid replacement hormone for 6-12 months; at that time the medication can be stopped and TSH level rechecked 6 weeks later to determine if the hypothyroid condition has resolved.

84.

A few days after an uncomplicated delivery, the mother develops irritability, bouts of crying, and anxiety. What is the likely diagnosis?

Baby blues, which begin within 1-2 weeks after delivery and resolves with reassurance; the ability to care for self and baby is preserved.

85.

What are the symptoms of postpartum depression?

Postpartum depression may begin within a week after delivery. It may last for months and involves extreme depression with loss of ability to care for self or child.

86.

What are the dangers of maternal parvovirus B19 infection?

Maternal parvovirus B19 in the first trimester can lead to spontaneous abortion; if infection occurs late in pregnancy, it can cause destruction of fetal red blood cells leading to anemia, heart failure, and fetal hydrops.

87.

How is gestational hypertension (HTN) defined?

New onset of HTN at ≥ 20 weeks gestation, in absence of proteinuria, and/or end organ dysfunction.

Systolic blood pressure (SBP) ≥ 140 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg on at least two separate readings during pregnancy

88.

What converts preeclampsia to eclampsia?

The onset of seizures or coma in someone with pre-eclampsia

89.

In what condition is screening for asymptomatic bacteriuria recommended?

Pregnant women should be screened for asymptomatic bacteriuria with a urine culture at 12-16 weeks’ gestation. There is no data to support testing or treatment of asymptomatic men or nonpregnant women regardless of age or underlying condition.

90.

Postcoital contraception with an intrauterine device (IUD) is effective if inserted within how many days?

Within 5 days

91.

How should a newborn be treated if the mother is hepatitis B surface antigen positive?

Hepatitis B immunoglobulin (HBIG) and the first injection of the hepatitis B vaccination series should be administered within 12 hours of birth.

92.

Women who develop cholestasis of pregnancy are at higher risk for postpartum cholestasis if exposed to what medication class?

Oral contraceptives can induce steroid-induced cholestasis.

93.

What is the first-line treatment for primary dysmenorrhea?

NSAIDs (i.e., naproxen)

94.

What intervention can be done to treat endometriosis if first-line therapies do not control symptoms?

For endometriosis not responsive to cyclic oral contraceptives, the patient may be tried on continuous contraception for 3-6 months or if there is chronic, noncyclic pelvic pain, placement of Levonorgestrel intrauterine device (IUD) will help.

95.

What are the firstline of therapies for endometriosis?

NSAIDs for the pain and combined oral contraceptives

96.

In a patient with known antiphospholipid antibody syndrome, what outcomes during pregnancy are increased?

Thromboembolism, recurrent fetal loss, thrombocytopenia

97.

Chronic-glucocorticoids administered during pregnancy can result in

Increased risk of cleft palate, gestational diabetes, pregnancy-induced HTN, premature rupture of membranes, fetal growth restriction, infection, osteoporosis

98.

In patients with what cancer is cancer antigen (CA) 125 used as a marker for treatment?

Ovarian cancer; there is strong evidence demonstrating no benefit and increased harm when used for screening and should NOT be used for this purpose.

99.

Where should a fetal monitor be placed when a baby presents with mentum anterior?

The chin

100.

When evaluating a woman for polycystic ovarian syndrome (PCOS), what LH:FSH ratio is consistent with the syndrome?

Greater than 2.5:1

101.

What conditions decrease alfa fetoprotein?

Gestational age older than expected, trisomy (Down syndrome), hydatidiform mole, fetal demise, increased maternal weight

102.

How is a screening done for gestational diabetes?

100 g 3-hour oral glucose tolerance test OR 75 g 2-hour oral glucose tolerance test

103.

What is the best test for the detection of symptomatic renal stones in a pregnant female?

Ultrasound; there is no radiation exposure as with CT scans.

104.

For what cancer is CA 27.29 used as a marker?

Breast cancer

105.

What conditions increase alfa fetoprotein?

Gestational age younger than expected, Neural tube defects: spina bifida, anencephaly, congenital skin defects, GI disorders (obstruction, liver disease, cloacal exstrophy), renal diseases (urinary obstruction, polycystic kidney disease), osteogenesis imperfecta, low birth weight, oligohydramnios, multiple gestations, decreased maternal weight

106.

What are the initial treatments for PCOS?

Use of metformin, weight loss by way of reduced carbohydrate intake, exercise, and oral contraceptives

107.

When a fetus has Down syndrome, what is the effect on the serum hCG level?

Serum hCG is about twice as high compared to an unaffected fetus.

108.

When a pregnant female is found to have an elevated alfa fetoprotein level, what diagnostic test should be done next?

Obstetrical ultrasound

109.

When during pregnancy should screening for gestational diabetes be done?

24-28 weeks’ gestation

110.

Patients with PCOS who want to get pregnant should be treated with what drug?

Clomiphene

111.

How long after birth does physiologic jaundice and bilirubin peak?

Days 3-4

112.

When gestational trophoblastic disease (hydatidiform mole) is suspected, what serum level should be obtained?

β-hCG (β-subunit of human chorionic gonadotropin)

113.

How should women with hepatitis C wishing to breastfeed be counseled?

Breast milk and breastfeeding does not transmit HCV; mothers with hepatitis C can breastfeed. However, if nipples are cracked or bleeding, they should temporarily stop breastfeeding.

114.

What nonhormonal medications are options for treating menopausal vasomotor instability?

Paroxetine (Paxil) and venlafaxine (Effexor); gabapentin (Neurontin) may also be used.

115.

Patients who are PPD converters during pregnancy without active disease should receive what therapy?

INH plus pyridoxine (vitamin B₆)

116.

Vacuum extraction may be attempted how many times?

Three

117.

In vacuum extraction, where should the cup be placed?

The cup should be placed over the sagittal suture and about 3 cm in front of the posterior fontanel.

118.

What is the risk of repairing episiotomies with skin sutures?

Skin sutures increase the incidence of perineal pain at 3 months after delivery.

119.

What dose of folic acid is recommended for women who have previously given birth to children with neural tube defects?

4 mg daily

120.

What dose of folic acid is recommended for women with no risk factors for neural tube defects?

400 µg daily

121.

In pregnant women with history of prior DVT, what drug should be given to lower the risk of a DVT recurring during subsequent pregnancies?

Low molecular weight heparin (warfarin is teratogenic).

122.

Pruritus gravidarum associated with severe pruritus in the third trimester is due to

Intrahepatic cholestasis

123.

What is a darkening of the skin of the face during pregnancy and with oral contraceptive use called?

Melasma

124.

True or false: acetaminophen is considered safe in all trimesters of pregnancy.

True

125.

What should you check in a pregnant woman with severe generalized pruritus but no obvious dermatosis?

Bile acid and LFTs for intrahepatic cholestasis of pregnancy

126.

True or false: NSAIDs are considered safe in all trimesters of pregnancy.

False: although commonly used, they may cause increased risks of miscarriage and malformations early in the pregnancy and exposure after 30 weeks’ gestation is associated with an increased risk of premature closure of the fetal ductus arteriosus and oligohydramnios.

127.

True or false: H2 antagonists and proton pump inhibitors are considered safe in all trimesters of pregnancy.

True, they are believed safe, but are only to be dosed on a daily basis if antacids or prn use is ineffective.

128.

For women in preterm labor, what agents can be used as tocolytics?

Terbutaline, magnesium sulfate, and nifedipine

129.

On screening ultrasound, the finding of an increased nuchal translucency seen at 10-14 weeks is consistent with what diagnosis?

Down syndrome

130.

Use of estrogen without progesterone can increase the risk of what condition?

Endometrial hyperplasia and endometrial cancer

131.

What is infarction of the pituitary gland during labor and delivery called?

Sheehan syndrome symptoms include inability to lactate, amenorrhea, and other symptoms of loss of pituitary function

132.

What is a common presentation of Sheehan syndrome?

Difficulty with breastfeeding after delivery

133.

Which partner should be evaluated first in an infertility evaluation?

Male (sperm analysis); the female evaluation is more extensive and expensive.

134.

How does basal body temperature change during ovulation?

It increases from 0.58°F to 1.08°F.

135.

How should women be counseled to sleep after 20 weeks’ gestation?

Pregnant women should sleep on their left side; sleeping on their back allows the enlarged uterus to possibly compress the great vessels leading to compromised blood flow to the uterus.

136.

What is the first test that should be done in women of childbearing age who present with abnormal uterine bleeding?

Serum hCG levels to check for pregnancy

137.

During labor a woman develops severe abdominal pain and/or has a tender uterus. What diagnosis should be ruled out?

Placental abruption

138.

What is the most common cause of excessive bleeding in the immediate postpartum period?

Uterine atony

139.

How is uterine atony treated following delivery?

Vigorous fundal massage and intravenous oxytocin

140.

What is the drug of choice for eclamptic seizures?

Magnesium sulfate

141.

What maneuver should be done first for the treatment of shoulder dystocia?

McRoberts maneuver, sharp hyperflexion of the mother’s thighs toward the mother’s abdomen

142.

What concerns are raised with repetitive variable decelerations found on fetal heart tracings?

Umbilical cord compression

143.

Repetitive late decelerations noted on fetal heart tracings during labor suggest what condition?

Uteroplacental insufficiency

144.

How many additional calories do pregnant women need per day?

300 calories

145.

What is the leading cause of nonobstetrical death in pregnant women?

Trauma; Motor vehicle accidents (MVAs) are the most common cause, followed by assault.

146.

How is preterm labor defined?

Traditionally, preterm labor is defined as <37 weeks and term labor between 38 and 42 weeks.

147.

What is early term labor?

Early term labor is between 37 weeks 0 days and 38 weeks 6 days.

148.

How is full-term labor defined?

Full term labor is between 39 weeks 0 days and 40 weeks 6 days.

149.

How is late-term labor defined?

Late term labor is between 41 weeks 0 days and 41 weeks 6 days.

150.

How is post-term labor defined?

Post term labor is between 42 weeks 0 days and beyond.

151.

Which HPV subtypes are most commonly associated with cervical cancer?

Types 16 and 18

152.

What bacteria is the most common cause of neonatal sepsis in the United States?

Group B Streptococcus

153.

How does breast conservation surgery in women with breast cancer affect their body image?

Improved body image

Higher satisfaction with treatment

No greater fear of recurrence compared with women treated with mastectomy

154.

What part of a woman’s menstrual cycle is the ideal time to perform a clinical breast examination in premenopausal women?

1 week after menses, when breasts are least swollen and tender

155.

What is the most common presentation of ectopic pregnancy?

Abdominal pain and spotting in the first 6-8 weeks after the last menstrual period is commonly associated with ectopic pregnancy.

156.

When spotting occurs in the first trimester, what laboratory test is useful in distinguishing a viable pregnancy from an ectopic pregnancy?

A β-hCG level that doubles in 48 hours is more likely to be a viable pregnancy. Correlate with findings of intra uterine pregnancy (IUP) on transvaginal ultrasound.

157.

To estimate gestational age during the first trimester, what ultrasound-based measurement is used?

During ultrasound in the first trimester, the crown-rump length best predicts gestational age.

158.

At how many weeks can an external version be attempted?

36 weeks’ gestation

159.

If using magnesium sulfate for eclampsia, what life-threatening side effect may occur?

Respiratory depression can be induced by magnesium sulfate.

160.

What is the treatment regimen for uncomplicated gonococcal infections?

The recommended regimen is a single dose ceftriaxone IM and single dose azithromycin oral dose.

161.

During pregnancy and in all patients, what is the drug of choice for treating of syphilis?

Penicillin G

162.

In preterm labor, what medication may be given prior to delivery to reduce mortality and morbidity (respiratory distress syndrome and intraventricular hemorrhage)?

Corticosteroids

163.

How does the lecithin-sphingomyelin (L/S) ratio and phosphatidylglycerol (PG) in preterm labor to determine lung maturity in the fetus?

Respiratory distress syndrome (RDS) is rare if the L/S ratio is > 2 and PG is present. If the L/S ratio is < 2 but PG is present, RDS develops in < 5% of infants.

164.

What percent of recognized pregnancies end in miscarriage?

Approximately 15%

165.

What drug is used to terminate an ectopic pregnancy? What must you rule out prior to starting medical treatment?

Methotrexate (MTX)

Must rule out viable intrauterine pregnancy

166.

In a pregnant patient with mild persistent asthma, what medication should be used to prevent asthma exacerbations?

Inhaled corticosteroids

167.

A vaginal discharge with a pH <4.5 implies what common infection?

Candida vulvovaginitis

168.

What are the effective and safe methods to treat pregnancy-induced nausea?

Acupressure, ginger, pyridoxine (vitamin B₆)

169.

What are the treatment options for women under 35 at low risk for uterine cancer with anovulatory bleeding?

Combination oral contraceptives (ethinyl estradiol ≤ 35 µg) or progesterone (Provera) 10 mg/day for days 10-14 days/month.

170.

Define premenstrual dysphoric disorder.

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS characterized by severe recurrent depressive and anxiety symptoms, with premenstrual (luteal phase) onset, which remits a few days after the start of menses.

171.

Define advanced maternal age.

Traditionally at least 35 years of age or estimated delivery date older than age 35

172.

What vaccines should not be given during pregnancy?

Measles, mumps, and rubella (MMR) Varicella